Attachment and Borderline Personality Disorder

• Published in: Journal of the American Psychoanalytic Association Vol. 48; no. 4; pp. 1129 - 1146
• Main Author: Fonagy, Peter
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Los Angeles, CA The American Psychoanalytic Association 2000; SAGE Publications; Sage
• Subjects: Adult; Adult and adolescent clinical studies; Attachment; Biological and medical sciences; Borderline personality disorder; Borderline Personality Disorder - etiology; Borderline Personality Disorder - psychology; Caregivers - psychology; Carers; Child; Child Abuse - psychology; Child Development; Childhood; Female; Fundamental and applied biological sciences. Psychology; Humans; Male; Medical sciences; Models, Psychological; Parent-Child Relations; Personality disorders; Predictors; Psychoanalysis; Psychoanalytic cure; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Reactive Attachment Disorder - psychology; Reflective skills; Self Psychology; Human; Analytical psychotherapy; Borderline; Infantile experience; Review; Victimology; Adult child relation; Personality disorder; Mental activity; Attribution; Parent child relation; Psychoanalytic cure; Child abuse; Treatment; Affective attachment; Conceptualization; Mechanism of action; Antecedent; Comparative study
• ISSN: 0003-0651; 1941-2460
• DOI: 10.1177/00030651000480040701

The author outlines his concept of reflective function or mentalization, which is defined as the capacity to think about mental states in oneself and in others. He presents evidence to suggest that the capacity for reflective awareness in a child's caregiver increases the likelihood of the child's secure attachment, which in turn facilitates the development of mentalization in the child. He proposes that a secure attachment relationship offers the child a chance to explore the mind of the caregiver, and in this way to learn about minds; he formulates this model of the birth of the psychological self as a variation on the Cartesian cogito: `My caregiver thinks of me as thinking and therefore I exist as a thinker.` This model is then applied to provide insight into some personality-disordered individuals who were victims of childhood abuse. The author proposes (1) that individuals who experience early trauma may defensively inhibit their capacity to mentalize to avoid having to think about their caregiver's wish to harm them; and (2) that some characteristics of severe borderline personality disorder may be rooted in developmental pathology associated with this inhibition. He offers evidence for and some qualifications of this model, and argues that the therapeutic effect of psychoanalysis depends on its capacity to activate patients' ability to evolve an awareness of mental states and thus find meaning in their own and other people's behavior.